Provider Demographics
NPI:1114215183
Name:DWYER, JEANNA (PT)
Entity type:Individual
Prefix:
First Name:JEANNA
Middle Name:
Last Name:DWYER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JEANNA
Other - Middle Name:
Other - Last Name:SHIRLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6625 LYNDALE AVE S STE 430
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2300
Mailing Address - Country:US
Mailing Address - Phone:952-285-2840
Mailing Address - Fax:
Practice Address - Street 1:6625 LYNDALE AVE S STE 430
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2300
Practice Address - Country:US
Practice Address - Phone:952-285-2840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist